Individual
ALWIN EDAKKUNNATHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5150 N PORT WASHINGTON RD STE 251, GLENDALE, WI 53217-5477
(414) 332-0606
(414) 967-3604
Mailing address
5150 N PORT WASHINGTON RD STE 251, GLENDALE, WI 53217-5477
(414) 332-0606
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3300-35
WI
Other
Enumeration date
05/29/2013
Last updated
04/17/2021
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